Tim Kinnaird1, Thomas Johnson2, Richard Anderson3, Sean Gallagher3, Alex Sirker4, Peter Ludman5, Mark de Belder6, Samuel Copt7, Keith Oldroyd8, Adrian Banning9, Mamas Mamas10, Nick Curzen11. 1. Department of Cardiology, University Hospital of Wales, Cardiff, United Kingdom; Keele Cardiovascular Research Group, Institute of Applied Clinical Sciences, University of Keele, Stoke-on-Trent, United Kingdom. Electronic address: tim.kinnaird2@wales.nhs.uk. 2. Department of Cardiology, Bristol Heart Institute, Bristol, United Kingdom. 3. Department of Cardiology, University Hospital of Wales, Cardiff, United Kingdom. 4. Barts Heart Centre, St Bartholomew's Hospital, Barts Health NHS Trust, University College London Hospitals NHS Foundation Trust, London, United Kingdom. 5. Institute of Cardiovascular Sciences, University of Birmingham, Birmingham, United Kingdom. 6. Department of Cardiology, James Cook University Hospital, Middlesbrough, United Kingdom. 7. Division of Statistics, Biosensors SA, Morges, Switzerland. 8. Department of Cardiology, Golden Jubilee Hospital, Glasgow, United Kingdom. 9. Department of Cardiology, John Radcliffe Hospital, Oxford, United Kingdom. 10. Department of Cardiology, University Hospital of Wales, Cardiff, United Kingdom; Department of Cardiology, Royal Stoke Hospital, University Hospitals of the North Midlands, Stoke-on-Trent, United Kingdom. 11. Department of Cardiology, University Hospital NHS Trust, Southampton, United Kingdom.
Abstract
OBJECTIVES: The authors used the British Cardiovascular Intervention Society (BCIS) national percutaneous coronary intervention (PCI) database to explore temporal changes in the use of intravascular imaging for unprotected left main stem PCI (uLMS PCI), defined the associates of imaging use, and correlate clinical outcomes including survival with imaging use. BACKGROUND: Limited registry data support the use of intravascular imaging during uLMS PCI to improve outcomes. METHODS: Data were analyzed from 11,264 uLMS PCI procedures performed in England and Wales between 2007 and 2014. Multivariate logistic regression was used to identify associates of imaging use. Propensity matching created 5,056 pairs of subjects with and without imaging and logistic regression was performed to quantify the association between imaging and outcomes. Multivariate logistic regression to identify the independent predictors of 12-month mortality was performed. RESULTS: Imaging use increased from 30.2% in 2007 to 50.2% in 2014 (p for trend < 0.001). The factors associated with imaging use included stable angina presentation (odds ratio [OR]: 1.200; 95% confidence interval [CI]: 1.147 to 1.246; p < 0.001), bifurcation LMS disease (OR: 1.220; 95% CI: 1.140 to 1.300; p < 0.001), previous PCI (OR: 1.320; 95% CI: 1.200 to 1.440; p < 0.001), and radial access (OR: 1.266; 95% CI: 1.217 to 1.317; p < 0.001). A lower rate of coronary complications, lower in-hospital major adverse cardiac events (OR: 0.470; 95% CI: 0.37 to 0.590; p < 0.001), and improved 30-day (OR: 0.540; 95% CI: 0.430 to 0.680; p < 0.001) and 12-month (OR: 0.660; 95% CI: 0.570 to 0.770; p < 0.001) mortality were observed with imaging use compared with no imaging use. Greater mortality reductions were observed with higher operator LMS PCI volume. In logistic regression modeling, imaging use was associated with improved 12-month survival. CONCLUSIONS: The observed lower mortality with use of intravascular imaging to guide uLMS PCI justifies the undertaking of a large-scale randomized trial.
OBJECTIVES: The authors used the British Cardiovascular Intervention Society (BCIS) national percutaneous coronary intervention (PCI) database to explore temporal changes in the use of intravascular imaging for unprotected left main stem PCI (uLMS PCI), defined the associates of imaging use, and correlate clinical outcomes including survival with imaging use. BACKGROUND: Limited registry data support the use of intravascular imaging during uLMS PCI to improve outcomes. METHODS: Data were analyzed from 11,264 uLMS PCI procedures performed in England and Wales between 2007 and 2014. Multivariate logistic regression was used to identify associates of imaging use. Propensity matching created 5,056 pairs of subjects with and without imaging and logistic regression was performed to quantify the association between imaging and outcomes. Multivariate logistic regression to identify the independent predictors of 12-month mortality was performed. RESULTS: Imaging use increased from 30.2% in 2007 to 50.2% in 2014 (p for trend < 0.001). The factors associated with imaging use included stable angina presentation (odds ratio [OR]: 1.200; 95% confidence interval [CI]: 1.147 to 1.246; p < 0.001), bifurcation LMS disease (OR: 1.220; 95% CI: 1.140 to 1.300; p < 0.001), previous PCI (OR: 1.320; 95% CI: 1.200 to 1.440; p < 0.001), and radial access (OR: 1.266; 95% CI: 1.217 to 1.317; p < 0.001). A lower rate of coronary complications, lower in-hospital major adverse cardiac events (OR: 0.470; 95% CI: 0.37 to 0.590; p < 0.001), and improved 30-day (OR: 0.540; 95% CI: 0.430 to 0.680; p < 0.001) and 12-month (OR: 0.660; 95% CI: 0.570 to 0.770; p < 0.001) mortality were observed with imaging use compared with no imaging use. Greater mortality reductions were observed with higher operator LMS PCI volume. In logistic regression modeling, imaging use was associated with improved 12-month survival. CONCLUSIONS: The observed lower mortality with use of intravascular imaging to guide uLMS PCI justifies the undertaking of a large-scale randomized trial.
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